Managed Care Administration of Public Long Term Care Programs: A Cost Effective Model?

  • Medicaid managed LTC programs have expanded across the states for the past decade and over 25 states now have some form of the model serving over 1.7 million beneficiaries. Most of whom live in FL, NY, TX, CA, OH, WI, MN, KS, IA, AZ, IL, NM, TN, NJ, MI and VA. Each of these states have at least 25,000 beneficiaries in MLTC plans, with Texas having the largest number by far with almost 600,000 in MLTC programs.
  • Several other states are planning or considering the implementation of MLTC program.
  • This steady expansion for profit corporate control in most of the Medicaid MLTC states is dramatically reducing the role of the non-profit Aging Network (AN) agencies in the administration of Medicaid LTC programs in most of the MLTC states.
  • This marginalization of the AN in LTC programs is occurring even though the AN organizations led the development of Medicaid waiver funded home and community based programs for most of the last 30 years.
  • The rationale for MLTC is often the unproven claim that private for-profit firms competing in free markets will generate better outcomes (access and quality outcomes) at lower or no greater cost than the FFS Medicaid program with the AN administering the HCBS waiver program.

– Dr. Jung Kwak, Dr. Larry Polivka

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